Mapping the inflammation in chronic rhinosinusitis with nasal polyps

Objective Chronic rhinosinusitis with nasal polyps (CRSwNP) in Europe is mostly associated with a type 2 inflammatory endotype based on local cytokine patterns. Our aim was to map the inflammatory involvement of affected structures, being polypoid and non-polypoid mucosa of the nose and sinuses in CRSwNP patients.

Methods The following tissues were separately collected from patients with moderate to severe CRSwNP: nasal polyps, inferior and middle turbinate biopsies, uncinate process mucosa and polypoid and non-polypoid mucosa from all sinuses. A total of 76 samples of 12 CRSwNP patients were retrieved. Inferior turbinates from 16 healthy patients without sinus disease were collected as controls. Concentrations of ECP, IgE, SE-IgE, IL-4, IL-5, IL-17 and TNF-a were measured.

Results Sinus mucosa, polypoid or not, of all sinuses and within the nasal cavity demonstrated the same inflammatory profile and a comparable degree of type 2 inflammation, significantly different from controls. No type 2 inflammation was found in control tissue. In patients with prior sinus surgery, SE-IgE was significantly higher in the maxillary sinus than in the other sinuses.

Conclusion This pilot study demonstrates for the first time that the type 2 inflammation in CRSwNP patients extends over all sinuses and the nasal mucosa alike, involving non-polypoid mucosa of the sinuses similarly to nasal polyps. This implies, that remodeling and inflammation in nasal polyps might be separate processes. Operated maxillary sinuses showed a higher expression of SE-IgE, suggesting that they are more prone to react to Staphylococcus aureus proteins. Abovementioned findings support the indication to perform extended sinus surgery for severe eosinophilic CRSwNP disease.

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Publication History

Article published online:
10 June 2020